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What next for Ontario’s top-billing doctors?

Are you curious if any of the specialists you’ve seen are among the richest doctors in Ontario?

You may soon be able to find out all this information thanks to a groundbreaking series of articles by the Toronto Star that removed the decades-old secrecy surrounding the province’s top-billing doctors.

Possibly the most important health-related story this year in Canada, the series used Ontario health ministry data that the Star obtained after a five-year court battle to identify 194 doctors across the province whose annual OHIP billings placed them in the Top 100 at least once between 2011 and 2018.

The top biller was Narendra Armogan, an ophthalmologist operating a huge eye clinic in Mississauga, who billed more than $42 million over the past seven years, an average of over $6 million annually.

To be clear, OHIP billings aren’t doctors’ take-home pay because overhead costs — such as staff salaries, rent and equipment — come out of their billings.

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Also, billing information about all 31,500 doctors in the province isn’t yet available, but the Ontario government is under intense pressure to make it public — not just now, but on an annual basis — as is the case in British Columbia, Manitoba and New Brunswick.

Still, the Star series will undoubtedly have sweeping implications for the top billing doctors, the provincial government and, ultimately, every patient in Ontario.

That’s because there is huge taxpayer money involved, some $12.1 billion a year in OHIP billings by doctors. We should know how it is spent. Who knew, for example, some doctor is billing $6 million annually every year?

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For patients, the question remains: Are we getting good value? When a general practitioner bills $400,000 for looking after 1,300 patients while a nurse practitioner looks after 800 patients for $120,000 and gets better satisfaction on average, serious questions must be raised.

Indeed, as one top medical expert notes, the economics of doctor care and payment is a serious public issue that has been hidden behind a shroud of professional mystery for far too long.

Another big issue for patients is “appropriateness,” which relates to whether doctors are ordering too many specialized treatments, tests and procedures, which in some cases means the doctors can submit increased billings to OHIP. Increased transparency into overall billing practices will go a long way in ensuring patients are getting the right treatments, tests and procedures.

For years, successive governments were afraid to take on the powerful Ontario Medical Association, which represents all doctors in the province, over the issue of revealing doctors’ incomes. It was considered too much of a political hot potato, although other provinces had already introduced legislation to make physician-identified billings public.

Back in 2013, though, the Star’s award-winning health reporter Theresa Boyle was reading one evening about how the U.S. was moving to release data on doctors’ incomes. A seed was planted. Why can’t that happened in Ontario, she wondered.

Boyle tried to get the data from the health ministry. She filed multiple freedom-of-access requests, met with ministry officials and consulted with outside experts. All her efforts failed.

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Finally, the Star went to court to get the data released, believing rightly that patients deserve greater transparency on how OHIP money is spent in the province. The OMA fought the Star all the way, spending countless dollars over five years to block the data release. In 2018, the Star finally won the case. The OMA appealed the ruling to the Supreme Court of Canada, which declined to consider its appeal.

In the wake of the Star series prepared by Boyle and a team of reporters and data analysts, all doctors — not just the top billers — will likely see patients who are silently wondering how much money they make and where they rank in terms of income.

For some doctors it may be an uncomfortable, albeit short-lived, experience. But now that the secrecy issue is behind us, both doctors and patients can move on to the truly important question of how to get the best value for the $12 billion we spend each year compensating our doctors.

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